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Friday, April 29, 2011

The Choice

You ever run a call on that homeless guy, or the drunk (sometimes the same person) and had PD there. If so, I'm sure you've probably heard the cop give the individual in need of "help" this offer: You either go to jail or to the hospital.


I hate this phrase. I understand why officers do this. They don't want to deal with said person, they don't want to do the paperwork and they probably figure that the hospital will do more good than jail. I completely understand those points. If I were in their shoes I would be tempted to do the same thing.

But, this practice comes at a price. Now this probably inebriated person is going to 'choose' to go to the hospital. Most of the time they never called 911 and they have no medical complaint. Now we have to take an ambulance out of service.

For those of you that don't know, ambulances don't grow on trees. If you have an emergency in my area, a firefighter paramedic will be there fast and is able to perform advanced life saving medicine. But he can't get you to the hospital. So now the ambulance that would have been there in 5 minutes is now transporting someone that doesn't really want to go to the hospital. The next ambulance is coming but they are 15 minutes away.

Once the patient gets to the ER he'll take up a bed. Have you ever had to wait to be seen in the ER? Now this patient will be seated in the ER waiting room since he has no real medical complaint but he's still taking up time, space and money when he originally didn't want to be there.

So is the answer to have to cops take the guy into custody? Is that going to accomplish anything? Would it be more wasteful? Maybe there's another answer out there. I'm not sure. I just hate that offer, jail or hospital.

Monday, April 25, 2011

The 7 Eleven Answer

Have you ever heard the question, if 7 Eleven is open 24 hours a day, 7 days a week, 365 days a year, why are there locks on the door? I know one of the answers.
We woke up for the 6th time that night. Maybe the 7th. It all was kind of fuzzy by this point. We had been to this address before. It is one of the locations that the homeless use to call us. Matter of fact, we were just there about 2 that morning for an assault victim.

As we approached the convenience store we scanned the phone booth and to our surprise, it was vacant. We then looked up and down the street for someone that may have called but still found nothing. Finally, after exhausting all other options, we went inside 7 Eleven.

As we walked in the door we were waved down by a man behind the counter. We walked over to find the 60 year old employee laying on the ground in pain. He said that he was moving a milk crate up onto a shelf when he started experiencing severe pain in his lower back. He said it felt as if someone had place a knife in his back.

Within a minute or two we had him loaded up on AMR's gurney. His replacement, who supposedly lived across the street, still had not shown up. So we decided to lock up 7 Eleven and call PD to babysit the joint until someone got there.

Incidentally, the only other time that I personally know of a closed 7 Eleven was during the riots in LA in the early 90's. When PD enforced the curfew, 7 Eleven shut down.

Thursday, April 21, 2011

Stabbing...Kind Of

For the fourth time that afternoon we were toned out to a medical aid with staging. This time it was for a stabbing at Rite Aid. We staged a half block away and watched as PD swarmed the area. They set up a perimeter really fast. They left us waiting for what seemed like an hour.


After about 5 minutes we were cleared to enter. We pulled up and jumped out. There was already caution tape stretched across the entrance. One of the officers raised it so we could slide past. Another officer, just inside the front door, directed us to the center of the store. We asked how bad it was and he said it wasn't.

As we approached the center of the store I noticed random drops of blood on the floor. As I turned onto the center isle I noticed a young man, in a security guard uniform, sitting on the floor. I didn't notice any bleeding so I asked him if he was hurt. He held up his and and I could see a bit of dried blood. I've seen paper cuts that have bled more.

The assailant had managed to take a small slice of skin off of the security guards thumb. I asked the guy if he wanted to go to the hospital, which he thankfully refused. As I placed a band-aid on his wound I asked if had had a recent tetanus booster. He had no idea. So before signing him out AMA I made sure he understood that he needed to go to his MD or a free clinic or an urgent care to get that shot.

As we walked out we canceled AMR. Another life saved (this last statement is literally dripping with sarcasm).

Monday, April 18, 2011

What Goes Down Must Go Up?

It had been a quiet shift. We decided to head over to the off road park to check things out. They were having a 3 day professional event which is fun to watch and usually good for providing a few calls. They always have a private paramedic ambulance on standby but anything serious or requiring manpower and we get a call. I told my engineer that every time we go over for a tour we end up getting a call there. It's almost as if the riders know we are close so they try some of the riskier moves, and fail.


We started down on the West side and worked our way East, stopping to people watch and to chat to the rangers. While traveling down the dirt road a dirt bike came at us in a hurry. A young man pulled up and said that a young girl had gone into the stream up one of the canyons. We flipped on the lights, notified the rangers and dispatch and headed that way. We also requested a helicopter figuring it's better to have it on its way and not need it than vice versa.

When we arrived at the accident we found a 11 year old girl laying on the trail. Her dirt bike was at the bottom of a 10 foot deep ravine. One of the "helpful" bystanders and decided to pull her up to the trail and take off her helmet. One of the rangers immediately grabbed c-spine for me. I can't say enough positive things about those rangers. They make my job easy.

A witness said that she had accidentally left her bike in neutral when she started down the hill. She accelerated to a speed which made it impossible for her to make the curve sending her into the stream below.

As I started my exam I noticed that she had a laceration above her right eye. The bleeding was relatively minor so I wasn't too concerned. The young lady kept complaining about her right foot. After my physical exam and noting that there were no other apparent injuries other than her cut and her foot my captain asked if I still wanted the helo. As I was about to say no I noticed that my patient started asking the same questions again, indicating a possible brain injury. I decided to fly her.

While some of the guys finished strapping her to a backboard others splinted her leg. I started an IV and then administered some morphine. I was working with an overtime captain and he was impressed that I even considered pain medication. I ended up giving the little girl as much as I could and it took the edge off of the pain from a possible fractured foot. Once all this was done we loaded her into the stokes basked on the back of the rangers 6 wheel ATV and headed down the hill. Part of our crew had already headed that way to set up an LZ.

Just as we got the the landing zone the helicopter appeared over head. Once I made sure the patient was safe from the rotor wash I snapped a quick video.

video

Once Calstar was on the ground we met up with the crew. I gave a report to the flight nurse who did a quick second check of the patient. We then loaded the girl onto the waiting helicopter, the engine never having shut down. Her father was going to get the ride of his life in the front seat.

video

After clearing the bird I took another video of them lifting off. In ten minutes she would be at Children's Hospital, instead of the hour it would have taken by ground ambulance.

Friday, April 15, 2011

Jealous Cops

Sometime around 0200 someone apparently assaulted a woman. It was enough of a fight that someone called the cops. When they arrived on scene and discovered that the victim had been pushed in the neck they called us.


Now there was a disconnect in communication somewhere. When we arrived on scene I found PD talking to the woman on the sidewalk. The first officer to talk to me said that she had no medical complaint. My immediate thought, "Then why are we here?!" As I approached, the victim (please note that I do not call her a patient) became agitated at our presence and made it well known that she didn't "need no firemen" and that she wasn't going to the hospital. I made sure she was able to refuse medical care and headed back to the engine.

As we finished loading our equipment one of the officers said that they had to call simply because she had been assaulted. I think they were just jealous that we were asleep and they weren't. Misery loves company.

Monday, April 11, 2011

Babies Bounce

Babies bounce. It's a cruel sounding euphemism describing the fact that babies are surprisingly resilient to falls. A lot of their bones are still made up of cartilage. And usually they don't fall from very high. So most of the time, when a little kid falls, they cry, brush themselves off and then keep going. Sometimes, over-reactive parents get involved and the equation changes.


We were toned out for a 2 year old fall with injuries. While normally calls involving kids amp me up just a touch this one didn't. We run calls like this all the time and very rarely is it anything serious.

When we arrived on scene we were met by a 6 year old girl. She led us to the upstairs apartment. Once inside we found her two year old brother screaming. His mom was holding him down on her bed. We slid into the room and the boy all but jumped into my engineers arms. Once he was out from under the confines his mother had set he became a happy kid. He was curious about our uniforms and babbled about his room. Acting like a healthy two year old.

Mom said she had not seen the fall but had found him at the base of the bed. I asked the sister what happened and she said that her brother had been jumping on the bed (probably not on his own) and he fell, feet first. I checked underneath the bed and found that it was indeed a trundle bed. The little guy had a small goose egg on his forehead with a straight scratch in it, which matched the edge of the metal frame.

He had evidently fallen feet first and then catapulted himself into the bed. The mother was still beside herself with panic. The entire time we were there my captain tried, in vain, to calm her down. She wanted to have her son taken to the hospital just to be sure nothing was wrong. He was happy until he had to be strapped into the car seat.

Wednesday, April 6, 2011

Do I Dare?

One of the blogs that my wife follows is In Pursuit Of Martha Points. Lori, the author, is participating in a fundraiser to help out the American Stroke Association. The way they raise money is by passing around this purse and get sponsors to donate for you to get dressed up and go out sporting this bag. And the big catch is that you have to take pictures and send them in. 


Yeah for Lori. I wouldn't think a lot about it except that my wife decided that she wants to participate. So now this purse is coming soon to our household. Once again, I didn't care too much. That was until my wife had the wonderful (I hope you can feel the sarcasm dripping from that word) idea to have me take the purse to the fire station.

I'm not sure she understands just how many man cards I would lose by taking a purse to the fire station. I'd lose one for having a purse. One for bringing it to work with me. Another for it being such a gaudy purse. And yet another for documenting it all on film (ok, digitally but you get the point). As consolation I get Martha points. Hhhhhhhmmmm.

But it is for a good cause. Stokes are somewhat frightening. They can hit at almost any age now. They can kill or maim you for life. Scramble your brain so you're a vegetable or worse, make it so you can think perfectly clearly but have no control over your body.

When a stroke happens there is a very small window of opportunity for decisive treatment. Once the brain tissue that is deprived of blood dies off it's too late. The latest studies show that we have about 4 hours from when symptoms begin to get treatment (assuming it's a clot that caused the stroke).

I remember once when I was working on an ambulance we received a morning ALS transfer from the local ER to UCLA medical center. When we got there we were told by the RN that our patient was a 30 year old woman that had had a stroke. They were trying to get her to UCLA so they could properly treat her. The problem, I knew, was that the small window of opportunity was closing fast. We told the nurse to call the receiving facility and let them know that we would be there in 25 minutes. We scooped up the patient, grabbed that paperwork and made a quick run to the hospital.

While in back of the box my partner found out that the patient had been getting ready for work when she lost the ability to speak or stand. Fortunately for her she made a lot of noise while collapsing to the floor. Her roommate came in and found her laying there, unable to speak.

As we walked into the UCLA ER we were met by the neuro-surgeon (I bet his paychecks are nice). We gave him a report and transferred the patient to a bed right in the hallway. From there the stroke team whisked her off to get treated.

Maybe the purse will end up visiting my fire house. Stay tuned....


For more information on the fundraiser visit their website: http://projectpurseandboots.com/

Tuesday, April 5, 2011

When To Panic

This post is for those not in emergency services. This is what to do when you are confronted by an emergency. Just a down and dirty way to help someone that needs you. This should not take the place of a first aid and/or CPR courses


First and foremost, when an emergency presents itself, stay calm. I understand that this is easier for some people than others. Take a second and plan your course of action. Then do it. Now for what to do.

We'll start with the bad one. If someone collapses unconscious in front of you, call 911. Then check for a pulse! Don't worry. If you forget what to do the 911 dispatcher will be able to walk you through it. If there is a pulse, keep checking on it and wait for the cavalry. If there is no pulse, start just compressions. If you don't want to then at the very least do compressions in the middle of their chest like you've seen on TV. Do compressions fast and hard. Keep going until trained personnel show up. If there is an AED grab it and follow the simple directions on the machine.


Severe bleeding. I would think that a lot of blood would freak a lot of people out. The first thing you should do is call 911. Then use something (preferably clean) like a towel or shirt and apply pressure directly on the bleed. This may hurt but it should stop the bleeding. If direct pressure doesn't stop it then apply a tourniquet above the wound. Get creative. Use a belt or something else that you can tighten to cut off blood flow.


Poisoning. Call 911 then call poison control. Follow their instructions. Even as a medic I still call them when my patients have overdosed on something with which I am not familiar.


If you have a fire, get out and call 911 from somewhere safe. Do not go back in to a burning building. All you'll end up doing is giving us someone else to rescue.


If you happen across a vehicle accident and people are injured. Call 911. The best thing for you to do is to stay safely belted in your vehicle. Roadways are among the most dangerous places that emergency service personnel have to function. Without proper training you would probably be putting yourself at great risk. If you do decide to stop, don't move someone from the vehicle unless it's on fire or going to fall off a cliff.


Basically, stay calm, call 911. They'll talk you through what you need to do. Just don't be afraid to help out.

Monday, April 4, 2011

Gardening

Just after dinner we were toned out to assist PD on a wellness check. A wellness check is what happens when someone doesn't hear from a neighbor or a family member in a while. They call PD and they call us. We all then go and see what's going on.


We arrived on scene just after PD. They directed us to the back of the house. The officer gave us a look that said all that we needed to know. I didn't bother with anything but my heart monitor. We walked through the small house that had been collecting random things for decades.

As we stepped through the sliding glass door into the backyard we noticed a small woman's body off to the right in her garden. She was laying half on the grass and half in her flowers with her tools next to her. Her body was cold and stiff to the touch. Her eyes were still open. There would be no resuscitation efforts. She was gone.

We went back inside and grabbed a sheet out of her linen closet and then draped the body. PD found some phone number in a cell phone and notified the next of kin. As we walked back outside the neighbor that had called 911 said more than asked that she was gone. He could tell by our mannerisms. I'm glad that we were still being professional.

Once back at the station we started in on dessert. Just another call.
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